Remote Utilization Management Nurse – Impactful Care

Cambia Health Solutions; Bellevue (WA); Remote; USD 4,822,000 - 7,852,000; Full time

Benefits offered by this job

Medical, dental & vision coverage

Health Savings Account

Generous paid time off

401(k) with company match

Parental leave up to 12 weeks

Wellness programs

Employee Assistance Fund

Job summary

Cambia Health Solutions is seeking a dedicated Utilization Management Nurse to support member care by performing prospective, concurrent, and retrospective reviews in a remote-capable role across multiple states.

You will apply clinical criteria, collaborate with interdisciplinary teams, and ensure compliance with care standards while maintaining thorough documentation and contributing to quality improvement initiatives.

Qualifications

• Associate or Bachelor’s Degree in Nursing or related field
• Must have licensure or certification in a health or human services discipline and 3 years of direct clinical care
• May need licensure in all four states served by Cambia: Idaho, Oregon, Utah, Washington

Responsibilities

• Conducts utilization management reviews (prospective, concurrent, retrospective) to ensure medical necessity and adherence to policy
• Applies clinical expertise and evidence-based criteria to make determinations
• Collaborates with interdisciplinary teams to facilitate transitions of care
• Provides accurate, timely responses to inquiries and maintains documentation
• Identifies opportunities for quality improvement and participates in related efforts

Skills

Case management

Utilization management

Communication skills

Clinical decision making

AI tools usage

Microsoft Office

Health care documentation systems

Education

Associate or Bachelor’s Degree in Nursing or related field

RN license (current, unrestricted)

Tools

Microsoft Office

Outlook

Documentation systems

Job description

Cambia Health Solutions is seeking a dedicated Utilization Management Nurse to support member care by performing prospective, concurrent, and retrospective reviews in a remote-capable role across multiple states.

You will apply clinical criteria, collaborate with interdisciplinary teams, and ensure compliance with care standards while maintaining thorough documentation and contributing to quality improvement initiatives.